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The burden of surgery and postoperative complications in children with inflammatory bowel disease
Emma Fehmel1, Warwick J Teague2, Di Simpson3
1Surgical Research, Murdoch Children's Research institute, Melbourne, Australia.
Insights
Surgery and complications are common in pediatric inflammatory bowel disease (IBD). Operations for Crohn's disease (CD) and ulcerative colitis (UC) are trending towards earlier intervention over time.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Inflammatory Bowel Disease Research
Background:
- Pediatric inflammatory bowel disease (IBD) presents significant challenges, often involving a high rate of surgical interventions and subsequent complications.
- Understanding the long-term surgical burden is crucial for managing pediatric IBD patients effectively.
Purpose of the Study:
- To quantify the surgical burden and postoperative complication rates in pediatric IBD over a 20-year period.
- To analyze trends in the timing of surgical intervention for pediatric Crohn's disease (CD) and ulcerative colitis (UC).
Main Methods:
- Retrospective review of pediatric IBD patients diagnosed between 1996 and 2015.
- Focus on operative interventions (excluding endoscopy) and associated postoperative outcomes.
- Comparative analysis of surgical timing and complication rates across two 10-year epochs.
Main Results:
- Of 786 IBD patients, 20.8% with CD and 10.7% with UC required surgery.
- Median time from diagnosis to surgery decreased significantly for both CD (34 to 3 months) and UC (62 to 6 months).
- Postoperative complications occurred in 13% of CD patients and 41% of UC patients, with UC having a higher complication frequency.
Conclusions:
- Surgery and postoperative complications are prevalent in pediatric IBD.
- A notable trend towards earlier surgical intervention has been observed for both CD and UC patients.
- The findings highlight the need for careful management of surgical risks in pediatric IBD.
Background:
Pediatric inflammatory bowel disease (IBD) may be associated with a higher burden of surgery and postoperative complications. This study aimed to measure the burden in pediatric IBD over a 20-year period in a large tertiary referral center.
Methods:
A retrospective review was conducted of children diagnosed with IBD between 1996 and 2015, with a focus upon operative intervention (excluding endoscopy) and postoperative outcomes.
Results:
Of 786 IBD patients, 121/581 (20.8%) with Crohn's disease (CD) and 22/205 (10.7%) with ulcerative colitis (UC) underwent surgery during the study period. When comparing 10-year epochs for CD, median time from diagnosis to intervention decreased from 34 months to 3 months (P < 0.0001). Postoperative complications occurred in 16/121 (13%) CD patients (bowel obstruction: 10, anastomotic stricture: 4, stomal issues: 4, anastomotic leak: 1). Within the UC cohort, the median time from diagnosis to intervention decreased from 62 months to 6 months (P = 0.0019). Postoperative complications occurred in 9/22 (41%) UC patients (bowel obstruction: 7, stomal issues: 3, anastomotic stricture: 1). Compared with CD, complications were more frequent in UC patients (P = 0.004).
Conclusion:
Surgery and postoperative complications are common in pediatric IBD. The timing of intervention has trended towards earlier operations in both CD and UC.
Level Of Evidence:
Treatment study-level III (retrospective comparative study).
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